Taking love seriously: the context of adolescent pregnancy in Colombia

Experiences of pregnancy in adolescence of internally displaced women in Bogotá: an ethnographic approach

Background

Pregnancy in adolescence is higher among internally displaced women in Colombia than non-displaced women. It is defined as a problem with significant negative outcomes by both biomedical and epidemiological approaches. However, little is known about pregnancy during adolescence from the perspective of women who experienced this in the specific context of armed conflict and displacement.

Aim

This article focuses on how internally displaced women understand their experiences of pregnancy in adolescence in the context of armed conflict through an ethnographic approach in a receptor community of internally displaced women in Bogotá, Colombia.

Methods

Based on 10 years of experience in the community, we conducted 1 year of fieldwork, using an ethnographic approach. We collected life stories of 20 internally displaced women through in-depth interviews and ran 8 workshops with them and other women from the community. We used thematic analysis to analyse the responses of internally-displaced women and understand how they made meaning around their experiences of adolescent pregnancy in the context of displacement.

Results

The main themes that emerged from participants’ experiences include rural violence, early family life (characterized by violence and mistreatment at home), meanings of pregnancy at an early age (including being challenged and feelings of love), and reactions to their pregnancies during adolescence (such as stigmatization) from their families and partners.

Conclusion

Our analysis of the in-depth interviews and the workshops suggests that adolescent pregnancy among women who are internally displaced has complex dynamics, characterized by the violent context of the rural areas, but primarily by the violence experienced during their childhood. The experience of pregnancy during adolescence brings feelings of ownership and also challenges, together with the forced displacement. This understanding will provide insights for policy makers and healthcare providers on how to work with this specific population who have experienced pregnancy in adolescence.

Labouring to Love

South Africa is 10 years into its new democratic order. An aspect of the country's political transformation has been an official political commitment to gender trans-formation. While great strides have been made towards greater gender equality at the institutional and legal level of society, the present article suggests that highly unequal power relations between men and women continue to be perpetuated in unexpected ways among those whom we would most expect to be capable of resistance. This paper is about how subtle yet deeply embedded ideologies and practices within heterosexual relationships serve to keep highly educated, apparently empowered and liberated women ‘in their place’, ensuring that they do not fulfil their potential. Traditionally women were socialised into assuming their positions in the home as caregivers and unpaid household labourers. The hope of feminism was that education, economic empowerment and an ideology of ‘can do’ independence would liberate women. However, for many women, it is in the most intimate aspects of their lives—in their sexual relationships with men—that this hope continues to be thwarted.

Perceived Facilitators and Barriers to Interventions Aimed at Reducing Unintended Pregnancies among Adolescents in Low and Middle Income (Developing) Countries: a Systematic Review of Qualitative Evidence

BACKGROUND

Adolescent pregnancies are most often the result of sexual risk taking. Such pregnancies are in themselves "risks" perpetuating other adverse social outcomes on the adolescents who go through such pregnancies. Of the close to 14 million births among adolescents each year, between one-third and two-thirds are unplanned. Unplanned pregnancies coupled with societal restrictions result in adolescents opting for abortions under unsafe conditions.

OBJECTIVES

The objective of this review is to present the best available evidence on perceived facilitators and barriers to successful outcomes of programs aimed at reducing pregnancies among adolescents in low and middle income countries.

INCLUSION CRITERIA

Persons aged between 10 and 19 years residing in low and middle income countries, but during the review process, those up to 25 years, adults and opinion leaders were included.Perceived facilitators and barriers to interventions aimed at reducing pregnancies among adolescents in developing countries.The review considered studies that used qualitative study designs, including but not limited to: phenomenology, grounded theory, action research, narrative studies, descriptive studies, ethnographies, cultural studies, behavioural studies, case studies and feminist research.

SEARCH STRATEGY

The search strategy aimed to find both published and unpublished studies in English over the period of January, 1960 to December, 2010.

METHODOLOGICAL QUALITY

Critical appraisal of papers was conducted using standardized tools from the Joanna Briggs Institute by two independent reviewers.

DATA COLLECTION

Data was extracted using standardized tools from the Joanna Briggs Institute.

DATA SYNTHESIS

Findings were synthesized on the basis of similarity of meaning using software from the Joanna Briggs Institute.

RESULTS

Fourteen studies were included in the review which generated 103 findings, grouped into 22 categories and then further grouped into 11 synthesized findings, based on similarity of meaning. Seventeen categories (eight synthesized findings) described perceived barriers and five categories (three synthesized findings) described perceived facilitators.

CONCLUSIONS

Synthesized findings on both the barriers and facilitators encompassed adolescent, parental, community, health facility, care providers, school environment and societal contributing factors.

IMPLICATIONS FOR PRACTICE

IMPLICATIONS FOR RESEARCH: Further research should be conducted into the following.

Field Work: Key to Qualitative Research

Objetivo: destacar la experiencia de la inserción al campo no sólo como la forma de recolectar información y determinar la calidad de los datos en que se basan los hallazgos, análisis y conclusiones, sino, también como elemento integrador del proceso de investigación que permita realizar una lectura de la realidad más específica. Método: a través de la investigación Experiencias de las adolescentes embarazadas en la localidad de Kennedy en la ciudad de Bogotá. Deseando el embarazo pero no tan pronto, se describen el estudio cualitativo y los antecedentes de la investigación, y se presentan las fases propias de la inserción. Conclusión: como método, la inserción al campo trasciende el acceso al dato; exige una acción dialéctica entre la teoría y la práctica, ya que el trabajo de campo requiere una formación teórico-metodológica y, al mismo tiempo, se sustenta en diversas técnicas y herramientas para la investigación.

Adolescent pregnancies in the Amazon Basin of Ecuador: a rights and gender approach to adolescents' sexual and reproductive health

In the Andean region of Latin America over one million adolescent girls get pregnant every year. Adolescent pregnancy (AP) has been associated with adverse health and social outcomes, but it has also been favorably viewed as a pathway to adulthood. AP can also be conceptualized as a marker of inequity, since it disproportionately affects girls from the poorest households and those who have not been able to attend school.

Using results from a study carried out in the Amazon Basin of Ecuador, this paper explores APs and adolescents' sexual and reproductive health from a rights and gender approach. The paper points out the main features of a rights and gender approach, and how it can be applied to explore APs. Afterward it describes the methodologies (quantitative and qualitative) and main results of the study, framing the findings within the rights and gender approach. Finally, some implications that could be generalizable to global reserach on APs are highlighted.

The application of the rights and gender framework to explore APs contributes to a more integral view of the issue. The rights and gender framework stresses the importance of the interaction between rights-holders and duty-bearers on the realization of sexual and reproductive rights, and acknowledges the importance of gender–power relations on sexual and reproductive decisions. A rights and gender approach could lead to more integral and constructive interventions, and it could also be useful when exploring other sexual and reproductive health matters.

Adolescent pregnancies and girls' sexual and reproductive rights in the amazon basin of Ecuador: an analysis of providers' and policy makers' discourses

Background

Adolescent pregnancies are a common phenomenon that can have both positive and negative consequences. The rights framework allows us to explore adolescent pregnancies not just as isolated events, but in relation to girls' sexual and reproductive freedom and their entitlement to a system of health protection that includes both health services and the so called social determinants of health. The aim of this study was to explore policy makers' and service providers' discourses concerning adolescent pregnancies, and discuss the consequences that those discourses have for the exercise of girls' sexual and reproductive rights' in the province of Orellana, located in the amazon basin of Ecuador.

Methods

We held six focus-group discussions and eleven in-depth interviews with 41 Orellana's service providers and policy makers. Interviews were transcribed and analyzed using discourse analysis, specifically looking for interpretative repertoires.

Results

Four interpretative repertoires emerged from the interviews. The first repertoire identified was "sex is not for fun" and reflected a moralistic construction of girls' sexual and reproductive health that emphasized abstinence, and sent contradictory messages regarding contraceptive use. The second repertoire -"gendered sexuality and parenthood"-constructed women as sexually uninterested and responsible mothers, while men were constructed as sexually driven and unreliable. The third repertoire was "professionalizing adolescent pregnancies" and lead to patronizing attitudes towards adolescents and disregard of the importance of non-medical expertise. The final repertoire -"idealization of traditional family"-constructed family as the proper space for the raising of adolescents while at the same time acknowledging that sexual abuse and violence within families was common.

Conclusions

Providers' and policy makers' repertoires determined the areas that the array of sexual and reproductive health services should include, leaving out the ones more prone to cause conflict and opposition, such as gender equality, abortion provision and welfare services for pregnant adolescents. Moralistic attitudes and sexism were present - even if divergences were also found-, limiting services' capability to promote girls' sexual and reproductive health and rights.

An interpretative phenomenological analysis of the lived experiences of young Chinese females in the course of unintended pregnancy

Research in the West has increasingly recognized the importance of understanding the perceptions and experiences of young pregnant females; however, limited studies are available in Chinese societies. This paper investigates the experiences of 10 young pregnant Chinese females living in Hong Kong. Through the use of individual interviews and the method of interpretive phenomenological analysis, the researchers were able to explore how the research participants made sense of their personal and social worlds. This research strategy also adds a cultural perspective in analyzing their stories in the context of Hong Kong. Recurrent themes identified in their stories revealed their thoughts, feelings, and actions in encountering the unintended pregnancy. The themes can be grouped into four categories, namely 1) pregnancy resolution: self-determination vs. significant others' influences; 2) emotional experiences after the termination of pregnancy: sense of relief vs. sense of guilt and sadness; 3) identity of young pregnant females: self-perception vs. others' perceptions and 4) pursuing an intimate relationship: love vs. sex. The findings provide a knowledge base for an understanding of the perspectives of young pregnant women and open up valuable reflections and discussions about adolescent pregnancy in Chinese societies. Implications can also be drawn for intervention, prevention, and research.

Adolescent maternity in a low income community: experiences revealed by oral history

Adolescent maternity involves relevant factors associated with each family, culture and society. This research aimed to describe the experiences in the trajectory of adolescent maternity. The oral history method was used, obtaining the narratives of 21 adolescent mothers living in a low income community located in São Paulo City, Brazil. The following descriptive categories emerged from the narratives: Pregnancy: an event in the initial phase of the relationship; Insufficient knowledge and access to contraceptives, gender inferiority and God's will: the ways to look at pregnancy; To escape from family problems and define the life course: the personal meanings attributed to pregnancy; More gain than pain: the balance of adolescent maternity. Adolescent maternity in low income contexts involves very complex factors and requires an integral, integrated, personal and family centered care.

Factors that shape young people's sexual behaviour: a systematic review

BACKGROUND

Since nearly half of new HIV infections worldwide occur among young people aged 15-24 years, changing sexual behaviour in this group will be crucial in tackling the pandemic. Qualitative research is starting to reveal how social and cultural forces shape young people's sexual behaviour and can help explain why information campaigns and condom distribution programmes alone are often not enough to change it. We undertook a systematic review to identify key themes emerging from such research, to help inform policymakers developing sexual health programmes, and guide future research.

METHODS

We reviewed 268 qualitative studies of young people's sexual behaviour published between 1990 and 2004. We developed a method of comparative thematic analysis in which we coded each document according to themes they contained. We then identified relations between codes, grouping them accordingly into broader overall themes. Documents were classified as either primary or secondary depending on their quality and whether they contained empirical data. From the 5452 reports identified, we selected 246 journal articles and 22 books for analysis.

FINDINGS

Seven key themes emerged: young people assess potential sexual partners as "clean" or "unclean"; sexual partners have an important influence on behaviour in general; condoms are stigmatising and associated with lack of trust; gender stereotypes are crucial in determining social expectations and, in turn, behaviour; there are penalties and rewards for sex from society; reputations and social displays of sexual activity or inactivity are important; and social expectations hamper communication about sex. The themes do not seem to be exclusive to any particular country or cultural background, and all themes were present, in varying degrees, in all countries assessed.

INTERPRETATION

This study summarises key qualitative findings that help in understanding young people's sexual behaviour and why they might have unsafe sex; policymakers must take these into account when designing HIV programmes. Considerable overlap exists between current studies, which indicates the need to broaden the scope of future work.